Do No Harm

Doctors at the frontline of the pandemic face down impossible choices

This series is devoted to reporting on the experience of doctors at the frontlines of the battle against coronavirus, as we approach what are likely to be some of the deadliest weeks in the history of the United States. Though their identities are known to the editors, the doctors interviewed will remain anonymous so that they do not face repercussions for sharing frank truths about practicing medicine in the midst of this crisis.

On Sunday, March 29, Dr. L[*] walked home in the dark after her shift at a New York hospital ended. The city felt uneasy, as if about to erupt in defiance of the imposed desolation keeping streets empty and noise limited to the unending wail of ambulance sirens. Dr. L lived close to the hospital, but on this dark and silent night, the two blocks seemed longer than ever.

In the days that had just passed, the hospital, almost all of which is now devoted to treating COVID-19 patients, had transitioned from anticipating the storm to being in the thick of it; Dr. L had overseen the conversion of more and more floors to COVID-19 floors. As the familiar hospital she and her colleagues knew transformed into a battlefield, they had begun to have the sort of conversations that had been unimaginable just a few weeks ago.

Dr. L recalled overhearing two nurses at a nursing station discussing imminent ventilator shortages. “Who would you save?” one nurse asked the other, “if you had one ventilator and had to choose between a young thirty-five-year-old or a seventy-year-old?” The second nurse didn’t answer. Looking at both, Dr. L interjected. “The hard choices are not going to be between a thirty-five-year-old and a seventy-year-old,” she said, “they’re going to be when you have to choose between a single thirty-year-old male and a forty-five-year-old male with three children.” The nurses just stared at her silently; the idea that they—health workers, nurses and doctors who had sworn to preserve life—would be deciding the value of one life against another still seemed abstract.

Dr. L thought about this conversation as she walked into her dark apartment, switching on the light. She was exhausted, but sleep seemed distant, only a theoretical possibility. She turned on the TV in her bedroom and the never-ending news loop began. The president had given a press conference earlier that day; now CNN was playing clips of it. Trump asked if the masks being sent to New York hospitals were “going out the back door.”

America is good at being in denial; its culture of youth-worship and predilection for projecting constant health make it particularly unsuited to dealing with death.

She was not one to be unnerved, not in general and particularly not by the president and his habitual insults. But this time was different. On the table next to the door lay her own N95 mask. It was the only one she had, and it had to be used again and again. When she was not wearing the mask, she carried it around in a brown paper bag she had been given for this purpose. Her bag was torn.

“The challenge,” Dr. L told me when we spoke the next day, “is trying to impress upon people how terrible this is.” She felt angry and frustrated. Twitter seemed full of people complaining about being cooped up at home, about their bad marriages, about not being able to go to restaurants. “I feel like the soldiers in Afghanistan must have felt; they probably looked at the devastation around them and felt abandoned. That is how I feel . . . abandoned.” Like troops sent off to fight distant wars, healthcare workers have been lauded as heroes but ultimately deemed disposable in the American psyche, offerings to be sacrificed to the virus while the comfortable worry about the boredom of their quarantines or what food to order from the delivery workers on the pandemic’s other frontline.

Dr. L’s frustration reflects the challenge facing an individualistic country used to compartmentalizing the violence it inflicts on its most vulnerable and on others. How can the stark and brutal life-and-death conditions inside hospitals be made as real as the issue of which shows to watch on Netflix or who to invite to one’s Zoom party? America is good at being in denial; its culture of youth-worship and predilection for projecting constant health make it particularly unsuited to dealing with death. Now, with so much death, a projected 100,000 to 240,000 if current social distancing measures are kept in place, the country may choose to just look away.

Just two days after the night that ended with Trump alleging New York doctors were selling masks, Dr. L attended a meeting to discuss the pandemic plan developed by the State of New York for allocating ventilators to patients. There are five categories of exclusion listed in the plan: cardiac arrest, “irreversible age-specific hypotension,” traumatic brain injury with no motor response to painful stimulus, severe burns with predicted survival odds of 10 percent or less, and a broad catch-all category of “other conditions resulting in immediate or near-immediate mortality even with aggressive therapy,” including progressive cancers.

It was a macabre and grim discussion. When it was over, Dr. L happened to glance at a television screen. It showed people crowding on beaches in Florida. “They don’t get it,” she thought, “they just don’t get it.”

Rafia Zakaria is the author of The Upstairs Wife: An Intimate History of Pakistan (Beacon 2015) and Veil (Bloomsbury 2017). She is a columnist for Dawn in Pakistan. She writes regularly for the Guardian, Boston Review, The New Republic, and The New York Times Book Review.